So perhaps this could tie back to what some of you already mentioned in this thread - that there may have been subtle neurological or behavioral differences present long before the formal development of full-blown ME/CFS.
I think the
sleep-disordered breathing paradigm provides a good explanation for a lot of this (once again lol).
Sleep apnea is associated with an increased prevalence of many psychiatric disorders; the below is data from the VA (see also
population-level data on panic disorder here).
Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort (Sharafkhaneh et al. 2005)
And this is just sleep apnea (technically they didn't distinguish between obstructive and central sleep apnea here, but central sleep apnea is pretty rare compared to OSA); imagine what it might look like with milder sleep-disordered breathing not meeting OSA criteria factored in -- especially if (some) psychiatric disorders follow a similar
pattern to "somatic syndrome" symptoms (and alpha-delta sleep) in sleep-disordered breathing patients (highest prevalence in mild sleep-disordered breathing patients with decreasing prevalence with increasing AHI, perhaps due to the fact that as frequency of apneas increases less time is spent in inspiratory flow limitation [the proposed stressor], though other factors may be relevant like women making up a larger % of mild sleep-disordered breathing patients).
Of note, alpha-delta sleep is associated with major depressive disorder in addition to fibromyalgia and UARS:
Prevalence and Correlates of Alpha-Delta Sleep in Major Depressive Disorders (it is also associated with rheumatoid arthritis [
1,
2], so it may reflect a general brain state of physiological hyperarousal from some form of sleep-disturbing afferent input -- whether peripheral nociceptive input or the brain's response to inspiratory flow limitation). I do cite multiple case reports of remission from chronic depression with treatment of OSA/UARS though:
And in this case report of remission from fibromyalgia with treatment of OSA (where alpha-delta sleep disappeared along with symptoms); a significant improvement in mental health was noted (supported by dramatic change in PHQ-9 scores), though resolution of depression was never explicitly stated:
Anyways, the below would lend support to the idea that psychiatric pathology may be more prevalent in mild sleep-disordered breathing patients (I agree with
@Utsikt that the concept of "personality" is fraught, and particularly flawed here; if you keep reading that thread I discuss how I think there is probably a bidirectional relationship: people with more naturally sensitive nervous systems may be more likely to develop a [worse] stress response to inspiratory flow limitation, and then the chronic nightly stress likely contributes to increased sensitivity, as well as anxiety and depressive symptoms in at least some patients). If you read the preceding posts in the thread I also discuss what I think might be going on with the finding of pre-morbid anxiety/depression being a risk factor for ME/CFS (basically, it could reflect some degree of milder UARS/OSAS stress response [which worsens with a new stressor into ME/CFS], or psychological stress-related anxiety/depression could be a risk factor for triggering the UARS/OSAS stress response -- either or both could be true depending on the case).
So it reads like «UARS: the unifying theory of everything?» (a bit of hyperbole)
Btw
@Utsikt this is starting to feel less and less like hyperbole
But anyways, I do think psychiatric disorders are heterogenous, a lot more so than ME/CFS (which presents with a very specific symptom cluster closely overlapping with that of UARS in the literature), so I don't necessarily think that UARS/OSAS is the primary driver of most chronic anxiety/depression/etc., but I think it could be a contributing factor in a large % of cases -- and the primary driver in a significant subset.
ETA: My personal possible prodromal onset experience:
Me. I had all of the above minus actual panic attacks (I've never had a true panic attack as far as I am aware). For about four years before the onset of my ME/CFS I had generalized anxiety, fluctuating DPDR, and episodic depression (though it was never melancholic/anhedonic depression; it seemed more anxiety-related: I would get episodes of intense anxiety accompanied by emotional distress/depression that would last for several days to weeks, often triggered by stressful life events). I used to think all of this was unrelated to my ME/CFS, but I lean towards thinking it's related/a prodromal phase now, especially because if I'm recalling correctly, the cold hands/feet started around the same time for me too. I had an acute (non-infectious) onset to my actual ME/CFS symptoms (rapid onset of fatigue over 1-2 weeks), although I don't remember having PEM at first, only fatigue and unrefreshing sleep (it was possible I had mild PEM and was not aware of it, but I definitely didn't have dramatic crashes early on in my illness).
